Biomedical subjects
Publications and source records attributed to C Pérez-Díaz.
Several years after sustaining head injuries, two patients developed oligodendrogliomas in the scar of brain contusions. Both cases seem to fulfill the criteria currently established for accepting the traumatic origin of a brain tumor. The literature concerning the relationship between head injury and intracranial tumor is reviewed.
INTRODUCTION: The dysembryoplastic neuroepithelial tumours, first defined by Dumas-Duport in 1988, are characterized histologically by being found in the cerebral cortex and having a histological pattern of multinodular architecture, foci of cortical dysplasia and a specific glioneuronal element. The clinical condition is characterized by seizures with a long evolution. These seizures are usually simple or complex partial seizures, but occasionally become generalized tonic-clonic seizures. Radiological findings on CAT or MR are cystic images localized to the cortex, with a solid component and do not cause displacement. The surgical operation required involves excision of the lesion or lesionectomy. This may be done so as to include 1 cm of the periphery of the lesion. The evolution is excellent and in most cases the seizures disappear. CLINICAL CASES: We present 4 cases of a series of 470 patients with tumours of the nervous system, operated on over the past 10 years in the Hospital del Niño Jesús. The evolution of these 4 cases has been from 1 to 5 years. In all 4 cases lesionectomy was carried out, and the evolution has been excellent (grade I of Engel's classification). CONCLUSIONS: 1. Dysembryoplastic neuroepithelial tumours are solid and cystic, situated in the cerebral cortex, with foci of cortical dysplasia. They are characterized by having a specific glioneuronal element. 2. Clinically they are characterized by crises with a long evolution. 3. The surgical operation involves lesionectomy or excision of the lesion. The evolution is excellent.
INTRODUCTION: Intervertebral disc herniation is a very common neurosurgical pathology. Most commonly disc disease occurs in adults and series published in children are only few and each reports only few cases. A genetic factor has been considered but in none of our patients there was a family history of disc disease. PATIENTS AND METHODS: We report ten patients with disc herniations in adolescents occurring among 1920 patients operated of herniated discs between 1988 and 1998. These herniations in adolescents were all related to some sport activities, and they occurred in the age range of 12 to 16 years. Symptoms were back pain and lower extremities pains of roots L5 or S1. All were studied with magnetic resonance imaging and in all patients the herniated disc was either in L4 L5 or L5 S1 intervertebral spaces. All disc were subligamental and 81.5% were posterolateral in position. Pathological studies of the herniated discs showed elastic consistency with high water content without degenerative changes. RESULTS: After microscopic removal of the herniated discs pain disappeared and remained so in the follow up. It was not necessary to reoperate in any of these patients and the postoperative follow up was between 2 and 5 years. CONCLUSIONS: Herniated disc disease is very infrequent in adolescents and all recovered completely after surgery, and the localization is posterolateral and subligamental.
INTRODUCTION: Intrathecal baclofen therapy (ITB) is a new tool in the integrated treatment of childhood spasticity. AIMS. We describe the eligibility and exclusion criteria used in the study and short term results of ITB therapy in our first five patients are also reported. PATIENTS AND METHODS: Our sample of patients consisted of three females and two males aged between 14 and 17 years. Two of them were ambulant (one without help and the other with crutches), two were serious non ambulant tetraparetics and the other was in a wheelchair but minimally ambulant. All of them satisfied our eligibility criteria. The main aims set out were to improve walking in the three patients with less serious involvement and to reduce or eliminate the pain and enhance quality of life (QOL) in the two more seriously affected patients. In all cases, the Baclofen test was positive. RESULTS: Follow up time was between 2 and 5 months. The objectives appear to have been accomplished, for the time being, in three patients: the two ambulant patients improved their capacity to walk and one male with serious spastic tetraparesis and pain no longer suffers from that pain and his QOL has improved. There were mild transient side effects in three patients. CONCLUSION: The selection of patients, including the definition of realistic tailor made objectives, is an essential step in ITB therapy. Results in our series, in the short term, indicate that ITB therapy can be efficient in ambulant and non ambulant patients, and offers few side effects.
INTRODUCTION: When symptomatic, arachnoid cysts (AC) must be treated surgically. The best surgical technique, however, is at the present time still subject to controversy -implantation of a cyst-peritoneal shunt (CPS) or fenestration of the cyst, either by means of a craniotomy or by using endoscopic techniques. PATIENTS AND METHODS: This paper reports the findings from a series of 18 patients under 10 years of age who were treated for symptomatic ACs. An increase in the cranial perimeter was observed in 12 patients, 4 had headaches and 2 children suffered convulsive crises. In 11 cases the location was supratentorial and in 7 it was found to be infratentorial. RESULTS: Treatment involved a cyst-peritoneal or ventriculoperitoneal shunt in 12 cases. Endoscopic treatment of the cyst was carried out in 5 of the patients and in 1 case craniotomy debridement was performed. Seven of the 18 children required a second intervention to resolve the clinical condition, either due to poor valve functioning or because the endoscopic treatment was insufficient. Complications included 2 subdural haematomas, which required surgical treatment. No mortality or morbidity occurred. CONCLUSIONS: The progress being accomplished in endoscopic techniques can make them the ideal form of treatment rather than craniotomy debridement techniques, although the high percentage of no-resolution in children below the age of 15 months must be taken into account. CPS solves the problem of these cysts with a lower degree of surgical risk, but it has a high rate of reintervention, as well as the dependence on the shunt. In the review of the literature we carried out it was seen that reports are still published concerning series treated by both cyst fenestration and by means of shunts.